# Ohio Admin. Code 5160-28-06.1: Rule 5160-28-06.1. FQHC and RHC services: limits on a per-visit payment amount (PVPA) determined on the basis of a cost report for an FQHC PPS service > Ohio · Regulations · In force URL: https://www.frixlaw.com/law-library/statutes/STATE_OH_ADC_5160_28_06_1 ## Section - **Citation:** Ohio Admin. Code 5160-28-06.1 - **Heading:** Rule 5160-28-06.1. FQHC and RHC services: limits on a per-visit payment amount (PVPA) determined on the basis of a cost report for an FQHC PPS service - **Jurisdiction:** Ohio - **Kind:** Regulations - **Status:** In force - **Text as of:** August 14, 2026 - **Source:** Compiled text - **Location:** Ohio Administrative Code / Agency 5160 / Chapter 5160-28 / Rule 5160-28-06.1 ## Text 119.03 (A) Allowable costs are calculated in accordance with the instructions for the FQHC cost report. Certain restrictions apply: (1) Costs related to direct inpatient care are not allowable. (2) Procedures or items that are not PPS services are not allowable. (3) The straight-line method of computing depreciation is used for all depreciable assets. (4) The cost claimed for services, facilities, and supplies furnished by a related organization cannot exceed the lesser of two figures: (a) The cost to the related organization; or (b) The price of comparable services, facilities, or supplies that are generally available in the competitive marketplace. (5) Total allowable administrative and general overhead costs cannot exceed thirty-five per cent of the costs of the services to which they are applied. Of these costs, not more than thirty thousand dollars are allowable annually as recruitment cost incurred by a provider of FQHC medical service. (B) Limits are established by applying tests of reasonableness to the allowable costs. (1) For each PPS service except transportation, a limit is established by dividing the allowable cost by the greater of two figures: (a) The total number of visits; or (b) The product of the actual number of direct hours worked by the professional and the applicable number of visits per hour from the following list: (i) Physician services, per physician 2.4; (ii) Physician assistant or advanced practice registered nurse services, per practitioner 1.2; (iii) Dental services 1.8; (iv) Physical therapy services 2.0; (v) Behavioral health services or substance use disorder services 0.7; (vi) Speech pathology and audiology services 1.8; (vii) Podiatry services 2.4; (viii) Vision services 1.9; (ix) Chiropractor services 2.4. and (x) Occupational therapy services 2.0; (2) For transportation, a limit is established of thirty-five dollars per unit of service Dental services 1.8; (iv) Physical therapy services 2.0; (v) Behavioral health services or substance use disorder services 0.7; (vi) Speech pathology and audiology services 1.8; (vii) Podiatry services 2.4; (viii) Vision services 1.9; (ix) Chiropractor services 2.4. and (x) Occupational therapy services 2.0; (2) For transportation, a limit is established of thirty-five dollars per unit of service. (C) Except for transportation services, ceilings are established at one hundred twenty per cent of the statewide sixtieth percentile PVPA for the respective PPS service. (D) The final PVPA for an FQHC PPS service, except transportation services, is the least of the allowable cost, the limit, or the ceiling. For transportation services, the final PVPA is the initial PVPA established in accordance with rule 5160-28-05 of the Administrative Code. Last updated July 2, 2024 at 10:47 AM Supplemental Information Authorized By: 5164.02 Amplifies: 5164.02 7/1/2029 7/1/2006 ## Nearby sections - [Ohio Admin. Code 5160-28-01 Rule 5160-28-01. Federally qualified health center (FQHC) and rural health clinic (RHC) services: definitions and explanations](https://www.frixlaw.com/law-library/statutes/STATE_OH_ADC_5160_28_01.md) - [Ohio Admin. Code 5160-28-02 Rule 5160-28-02. FQHC and RHC services: conditions affecting medicaid provider participation](https://www.frixlaw.com/law-library/statutes/STATE_OH_ADC_5160_28_02.md) - [Ohio Admin. Code 5160-28-03 Rule 5160-28-03. FQHC and RHC services: covered services, limitations, and copayments](https://www.frixlaw.com/law-library/statutes/STATE_OH_ADC_5160_28_03.md) - [Ohio Admin. Code 5160-28-04 Rule 5160-28-04. FQHC and RHC services: submission of a cost report](https://www.frixlaw.com/law-library/statutes/STATE_OH_ADC_5160_28_04.md) - [Ohio Admin. Code 5160-28-05 Rule 5160-28-05. FQHC and RHC services: prospective payment system (PPS) method for determining payment](https://www.frixlaw.com/law-library/statutes/STATE_OH_ADC_5160_28_05.md) - [Ohio Admin. Code 5160-28-06.1 Rule 5160-28-06.1. FQHC and RHC services: limits on a per-visit payment amount (PVPA) determined on the basis of a cost report for an FQHC PPS service](https://www.frixlaw.com/law-library/statutes/STATE_OH_ADC_5160_28_06_1.md) - [Ohio Admin. Code 5160-28-07.1 Rule 5160-28-07.1. FQHC and RHC services: alternate payment method (APM) for determining payment for government-operated FQHCs](https://www.frixlaw.com/law-library/statutes/STATE_OH_ADC_5160_28_07_1.md) - [Ohio Admin. Code 5160-28-12 Rule 5160-28-12. Establishment of a per-visit payment amount (PVPA) derived from a cost report submitted by a federally qualified health center (FQHC) or rural health clinic (RHC) site affected by a public health emergency (PHE) declaration](https://www.frixlaw.com/law-library/statutes/STATE_OH_ADC_5160_28_12.md) --- Source: Frix Law Library, https://www.frixlaw.com/law-library/statutes/STATE_OH_ADC_5160_28_06_1. Check the current official text before relying on it. Not legal advice.